As competency assessment methods evolve, nursing administrators’ and educators need to prepare for the growing number of new graduate nurses as they must be able to deliver effective and safe care as early as possible in their nursing careers (Nursing Executive Center, 2008). In a recent report published by the Nursing Executive Center (2008), the authors identified that a broad analysis of new graduate practice is not helpful. They suggest a much more detailed understanding of specific shortfalls that will in turn close the gap in knowledge between
academic preparation and practice. Specifically, they identified critical thinking as one of the top priorities. Mutually agreed upon competencies include the ability to recognize the patient status, anticipate risk, interpret assessment data, facilitate decision making, and recognizing when to ask for assistance (Nursing Executive Center, 2008). In order to reach the goal of understanding areas of needed remediation, alternative methods of evaluation such as VTV and HFHS may be better options as they provide a more interactive, detailed oriented environment which offers debriefing to facilitate learning (Henrichs et al., 2002, Feingold et al., 2004, Bearnson & Wiker, 2005, O’Donnell et al., 2005, Trossman, 2005).
Student nurses’ performance reflected difficulty meeting expectations when tested in a simulated setting. HFHS appeared to best approximate scores on a standardized measure of
critical thinking skills in the clinical setting. This will allow both nursing educators and administrators to determine the best, most-cost effective method of evaluation to aid in the transition of new graduates into the workforce.
APPENDIX A
SCRIPT FOR FACULTY MEMBER INTRODUCING THE STUDY
Hello. I am pleased to introduce xxxxx, a Doctoral student at the University of Pittsburgh School of Nursing. She is here today to ask for your permission to participate in a research study entitled “Evaluation of Critical Thinking Skills During Simulated Laboratory Performance Utilizing a Videotaped Vignette and High Fidelity Human Simulation”. The purpose of this study is to determine if students enrolled in different types of nursing programs differ in their critical thinking skills or performance scores when two methods of evaluation are used – videotaped vignettes and high fidelity human simulation. She is hoping to recruit at least 16 students from this program. Those of you who are 18 years of age or older, able to read and speak English, and enrolled in your last term of academic preparation might be eligible to participate. XXXX is here today to explain the study in more detail for those of you who may be interested in participating.
APPENDIX B
SCRIPT FOR RESEARCHER
Hello. My name is xxxxxxx. I am here today to ask for your permission to participate in a research study to determine if students enrolled in different types of nursing programs differ in their critical thinking skills or performance scores when two methods of evaluation are used – videotaped vignettes and high fidelity human simulation. I am recruiting nursing students from three nursing programs. In order to participate, you must be 18 years of age or older, able to read and speak English, and enrolled in your last term of academic preparation. If you have trained as an EMT, paramedic, or licensed practical nurse, or are enrolled in a 2nd degree or RN options program, you are not eligible.
If you elect to participate in this research study, I will ask you to complete a brief demographic questionnaire which will take approximately 5 minutes to complete, the California Critical Thinking Disposition Inventory which takes approximately 25 minutes to complete and the California Critical Thinking Skills Test which takes about 45 minutes to complete. You will then participate in a clinical scenario using a videotaped vignette and a second clinical scenario using high-fidelity human simulation. The study will take place at xxxxxxx.
I hope to recruit 48 nursing students (16 from each program) to participate in this study. There are few risks associated with this study. You may feel embarrassed if you perform poorly. We will not discuss your performance with others and your individual score will not be shared with school faculty or other participants. By taking the CCTDI, the CCTST and participating in both simulated scenarios, you may receive an educational benefit through the practice of taking these critical thinking examinations.
You do not have to participate. Your grade will not be affected if you choose not to participate. You may withdraw from the study at any time without incurring any penalty. All answers and data will be kept strictly confidential and kept in a locked file. You will be provided lunch the day of the study, be compensated for parking, and receive a $10 gift- certificate for participation. Does anyone have any questions?
If you choose to participate, please complete the second page of this form and return it to me now. I will collect these forms and use this information to notify you regarding the time and location of the testing. If you have any further questions, you can contact me, xxxxxx at xxxxxx or via email at xxxxxxx. Thank you for your time and consideration given to participating in this study.
I, ___________________________________________________, agree to participate in the study Evaluation of Critical Thinking Skills During Simulated Laboratory Performance Utilizing a Videotaped Vignette and
High Fidelity Human Simulation. I meet the eligibility and exclusion criteria listed below. I agree to be contacted at the following email address or telephone number regarding the time and location of the testing:
Email___________________________________________________________
Contact phone number ____________________________________________
Inclusion Criteria:
• Student nurse 18 years of age or older, able to read and speak English
• Student nurse who is not licensed to practice as an RN and enrolled in the last term of academic preparation at an accredited nursing school
Exclusion Criteria:
• Preparation as an emergency medical technician, paramedic, or licensed practical nurse • Enrollment in a 2nd degree accelerated or RN options program
APPENDIX C
DEMOGRAPHIC SHEET
ID Number__________________________
What is your current age? ___________
What is your race? Caucasian African-American Hispanic Asian Other
What is your gender? Male Female
What program are you enrolled in? Diploma Associate Baccalaureate
Did you participate in an Internship/Residency Program? Yes No
Have you worked in a hospital as a Nurses Aide? Yes No
APPENDIX D
VTV REFERENCE SHEET
Make sure your answers are specific... ID Number _______________________
Simulated Laboratory Performance - VTV Reference Sheet
Problem Recognition:
Synthesize the information you have been given and tell us what you think is going on.
Please synthesize the clinical data that you see into ONE problem label. A medical diagnosis is most acceptable, but if you choose to write a nursing diagnosis, please keep in mind that it must be VERY
SPECIFIC. Do not simply list all the signs/symptoms. Problem Management-Report essential
clinical data:
What will you report?
To whom? Should this be reported “stat”?
Be specific… To whom will you report? “Report assessment
changes, lab values, or clinical data” is not enough… What will you report? Is reporting this data urgent?
Example: Notify MD “stat” of blood pressure, intake and output,
pain, shortness of breath, potassium level, glucose level…..
Problem Management- Initiates independent
nursing interventions and assessments:
What would you do to manage this problem?
What would you anticipate will be done? What would you assess?
What information do you need?
What interventions can you implement on your own?
Does anything need to be done “stat”?
What will you assess or continue to monitor? Be specific. If you will assess vital signs, please list the specific vital signs that you will assess. Do any of these interventions need to be done urgently?
Example: Assess lung sounds, neurological status, pedal edema,
blood sugar values…..
What will you do for the patient as nursing interventions? Patient teaching? Safety measures? Comfort measures? Be specific.
Problem Management-Anticipate relevant
medical orders:
What orders would you anticipate will be started for this patient?
What orders would you recommend based on
your assessment?
Is there anything you would hold, stop, or
What orders will you anticipate – medical and nursing? Continued lab work or diagnostic work-up are not sufficiently specific. Is there anything that you would hold or stop? Are any of these orders or interventions urgent?
Example: Anticipation of a diuretic, antibiotic, or hemoglobin and
Rationale:
Correlate your interventions with the rationale.
Why are you doing this intervention for this patient?
APPENDIX E
VTV SAMPLE SCENARIO
Narrative Description
XXXXX is a 22-year-old carpenter who fell from a roof this morning. He sustained a fractured pelvis and ruptured spleen. He underwent an emergency splenectomy and returned from the recovery room one hour ago.
Clinical Data
APPENDIX F
VTV ASSESSMENT TOOL
Make sure your answers are specific... ID Number _______________________
Simulated Laboratory Performance - VTV Assessment Tool
Problem Recognition:
Synthesize the information you have been given and tell us what you think is going on.
Problem Management-Report essential clinical data:
What will you report? To whom?
Should this be reported “stat”?
Problem Management-Initiates independent nursing interventions and assessments:
What would you do to manage this problem? What would you anticipate will be done? What would you assess?
What information do you need?
What interventions can you implement on your own?
Does anything need to be done “stat”
Problem Management-Anticipate relevant medical orders:
What orders would you anticipate will be started for this patient?
What orders would you recommend based on your assessment?
Is there anything you would hold, stop, or discontinue?
Are any of these orders “stat”?
Why are you doing this intervention for this patient?
APPENDIX G
VTV TESTING SCENARIO
Narrative Description
While building a tree house for his children, xxxxxxx fell, striking a bicycle prior to hitting the ground. He sustained a ruptured spleen and multiple contusions. Since his splenectomy yesterday, he has been stable.
Clinical Data 8am Temperature 99.4 Blood Pressure 118/74 Pulse 82 Respirations 18
Interim Blood Gas Report 8:30am
Reference Room Air
pH 7.35 – 7.45 7.51 PaCO2 35 – 45 mm Hg 28 PaO2 80 – 100 mm Hg 70
APPENDIX H
VTV/HFHS ASSESSMENT TOOL – PULMONARY EMBOLISM
ID Number________________ VTV/HFHS Assessment Tool – Pulmonary Embolism
Problem Recognition Met Expectations Did Not Meet Expectations
Pulmonary Embolism (blood clot to the lungs)
or Pneumothorax
(punctured or collapsed lung)
Overall Subsection Rating (Must meet expectation)
Problem Management: Reports Essential Clinical Data
Reports chest pain or discomfort or
Reports shortness of breath or
Compromised respiratory status Reports all vital signs
(temp, pulse, respirations, BP) Reports previously obtained
blood gas values (pH, PaCO2, and PaO2) Overall Subsection Rating
Problem Management: Initiates Independent Nursing Interventions and Assessments
Provides verbal reassurance to patient Completes lung sound assessment Places pulse oximeter on patient Administers oxygen therapy
Overall Subsection Rating (Must meet all 4 expectations)
Problem Management: Anticipates Relevant Medical Orders
Anticipates order for CXR or CT Scan Anticipates order for additional blood gas (pH, PaCO2, and PaO2)
Anticipates order for PT/PTT
Overall Subsection Rating (Must meet all 3 expectations) Rationales:
Calling MD Stat
Reporting chest pain or discomfort or
Reporting shortness of breath or
Reporting compromised respiratory status Reporting all vital signs
(temp, pulse, respirations, BP) Reporting previously obtained
blood gas values (pH, PaCO2, and PaO2) Providing verbal reassurance to patient Completing lung sound assessment Placing pulse oximeter on patient Administering oxygen therapy
Anticipating order for CXR or CT Scan Anticipating order for additional blood gas (pH, PaCO2, and PaO2)
Anticipating order for PT/PTT
Overall Subsection Rating (Must meet all 11 expectations)
Prioritization:
Calls MD (stat)
Overall Subsection Rating (Must meet expectation)
Overall Assessment Rating: Participant must meet expectations in any four of the six subsections (problem recognition, problem management-reports essential clinical data, problem management-initiates independent nursing interventions and assessments, problem management- anticipates relevant medical orders, rationale, and prioritization).